Mitochondrial Neurogastrointestinal Encephalomyopathy Caused by A Novel TYMP Gene Mutation in An Adult Patient
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摘要:
目的 探讨线粒体神经胃肠脑肌病患者的临床表现及基因突变情况。 方法 分析1例成人线粒体神经胃肠脑肌病患者临床资料, 对患者及其家系线粒体病相关基因应用NimbleGen固相芯片进行目标区域捕获测序。 结果 该患者表现为进行性加重的假性胃肠梗阻、脑白质病、恶液质、周围神经病、眼外肌无力及多种代谢紊乱。基因检测发现TYMP基因c.217G>A纯合突变为该患者的致病突变, 患者父母(近亲婚配)及姐姐均为该突变杂合子, 该突变为新发突变。 结论 经基因检测确诊TYMP基因新发突变致成人线粒体神经胃肠脑肌病。 -
关键词:
- 线粒体神经胃肠脑肌病 /
- 胸腺嘧啶核苷酸磷酸化酶基因 /
- 基因突变
Abstract:Objective To analyze the clinical features and genetic background of mitochondrial neurogastrointestinal encephalomyopathy (MNGIE). Methods The clinical data of an adult patient with MNGIE were retrospectively reviewed. Meanwhile, the mitochondrial disease-related gene of the patient and his families were detected by target area capture sequencing with NimbleGen solid phase chip. Results This patient presented with progressive pseudo-gastrointestinal obstruction, leukoencephalopathy, cachexia, peripheral neuropathy, extraocular muscle weakness, and multiple metabolic disorders. A homozygous mutation (TYMP gene c.217G>A) was identified. The patient's parents and sister were heterozygous for this novel mutation. Conclusion A novel TYMP gene mutation that caused MNGIE in a Chinese adult patient was confirmed by gene detection. -
表 1 患者致病基因检测情况
基因 NM编号 核苷酸变异 比率(参照/变异) 氨基酸变异 突变类型 TYMP NM_001953 c.217G>A 0/107 p.Ala73Thr 错义突变 MT- RNR2 YP_003024026 m.2805A>T 948/233 — 点突变 -
[1] Hirano M, Silvestri G, Blake DM, et al. Mitochondrial neurogastrointestinal encephalomyopathy (MNGIE):clinical, biochemical, and genetic features of an autosomal recessive mitochondrial disorder[J]. Neurology, 1994, 44:721-727. doi: 10.1212/WNL.44.4.721 [2] Libernini L, Lupis C, Mastrangelo M, et al. Mitochondrial Neurogastrointestinal Encephalomyopathy:novel pathogenic mutations in thymidine phosphorylase gene in two Italian brothers[J]. Neuropediatrics, 2012, 43:201-218. doi: 10.1055/s-0032-1315431 [3] 许二赫, 张弥兰, 董会卿, 等.线粒体神经胃肠型脑肌病的临床和病理分析[J].中风与神经疾病杂志, 2013, 30:396-399. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=zfysjjbzz201305003 [4] 唐吉刚, 李传芬, 李靖, 等.线粒体神经胃肠脑肌病一例临床、病理及基因分析[J].中华神经科杂志, 2014, 47:26-29. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=zhsjk201401007 [5] Shoffner JM. Mitochondrial neurogastrointestinal encephalopathy disease[M]//Pagon RA. GeneReviews.Seattle: 2005, 22. [6] Hirano M, Nishigaki Y, Marti R. Mitochondrial neurogastrointestinal encephalomyopathy(MNGIE):a disease of two genomes[J]. Neurologist, 2004, 10:8-17. doi: 10.1097/01.nrl.0000106919.06469.04 [7] Nishino I, Spinazzola A, Hirano M. Thymidine phosphorylase gene mutations in MNGIE, a human mitochondrial disorder[J]. Science, 1999, 283:689-692. doi: 10.1126/science.283.5402.689 [8] Teitelbaum JE, Berde CB, Nurko S, et al. Diagnosis and management of MNGIE syndrome in children:case report and review of the literature[J]. J Pediatr Gastroenterol Nutr, 2002, 35:377-383. doi: 10.1097/00005176-200209000-00029 [9] Glover EI, Martin J, Maher A, et al. A randomized trial of coenzyme Q10 in mitochondrial disorders[J]. Muscle Nerve, 2010, 42:739-748. doi: 10.1002/mus.21758 [10] Chen RS, Huang CC, Chu NS. Coenzyme Q10 treatment in mitochondrial encephalomyopathies. Short-term double-blind, crossover study[J]. Eur Neurol, 1997, 37:212-218. doi: 10.1159/000117445 [11] DiMauro S, Hirano M, Schon EA. Approaches to the treatment of mitochondrial diseases[J]. Muscle Nerve, 2006, 34:265-283. doi: 10.1002/mus.20598 [12] Hussein E. Non-myeloablative bone marrow transplant and platelet infusion can transiently improve the clinical outcome of mitochondrial neurogastrointestinal encephalopathy:a case report[J]. Transfus Apher Sci, 2013, 49:208-211. doi: 10.1016/j.transci.2013.01.014 [13] Halter J, Schüpbach WM, Casali C, et al. Allogeneic hematopoietic SCT as treatment option for patients with mitochondrial neurogastrointestinal encephalomyopathy (MNGIE):a consensus conference proposal for a standardized approach[J]. Bone Marrow Transplant, 2011, 46:330-337. doi: 10.1038/bmt.2010.100 [14] Nishino I, Spinazzola A, Papadimitriou A, et al. Mitochondrial neurogastrointestinal encephalomyopathy:an autosomal recessive disorder due to thymidine phosphorylase mutations[J]. Ann Neurol, 2000, 47:792-800. doi: 10.1002/1531-8249(200006)47:6<792::AID-ANA12>3.0.CO;2-Y [15] Tarnopolsky M, Stevens L, MacDonald JR, et al. Diagnostic utility of a modified forearm ischemic exercise test and technical issues relevant to exercise testing[J]. Muscle Nerve, 2003, 27:359-366. doi: 10.1002/mus.10330